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No Epidural? Pain management alternatives and tips – Part 1

In a previous article, 42 weeks explored the epidural and other medical pain relief interventions for labour. You can read it here: Epidural, Is it right for You?

This week, 42 weeks looks at ways to manage labour without the use of medical pain relief.

A father applies pressure to his partner in labour. Taken from the 42 Weeks Gallery.

Your experience of labour and birth should be just that — yours. Every birth is unique and each woman will approach childbirth in her own way. This article looks at options for women who choose to give birth without the use of medical pain relief.

Why do women avoid medical pain relief?

There are many reasons why you might choose to avoid medical pain relief. These may include:

* you would like to feel in control
* you are worried about having a negative reaction to medical pain relief – sickness, dizziness, etc
* you would like to experience labour
* you would like to feel your baby being born
* you are afraid of needles
* you would like to avoid a change of risk status (epidural changes your risk status from low to high risk)
* you would like to avoid increased risk of interventions
* you do not want to increase your risk of Caesarean section or assisted delivery
* you would like to move about freely in labour
* you would like to give birth in an upright position or off the bed
* you would like to labour or birth in water
* you would like access to midwife led care (MLU or DOMINO or homebirth)
* you want to avail of the early release home scheme
* you would like to avoid a catheter
* you would like to avoid continuous monitoring with CTG
* you would like to avoid drugs that cross the placenta to your baby
* you would like to breastfeed and are concerned pain medications interfere with the initiation of feeding

Your Birthing Environment

The environment you labour and birth in can have a strong influence on your overall birth experience and ability to cope. A birthing environment should be supportive, encouraging, and relaxed. Your brain reacts to stressful and clinical environments. Fear and resistance to what feels natural to you can cause your body to react as if it is in danger – a fight or flight response. If you experience an excessively stressful situation, your body reacts by charging up hormones, like adrenaline, to prepare your body to either stay and fight or to flee from the stressful environment you find yourself in. Once the fight or flight response is activated, your blood pressure and heart rate is raised. You have increased muscle tension. Your pupils dilate and you experience increased perspiration. If fight or flight is activated in labour, it is counter-productive to the environment you need to help your body relax and an inhibitor of oxytocin – making labour longer and more painful.

This fantastic video creatively looks at how environment plays an important part in how we labour.

Creating a Positive Birthing Environment

* Choose a birth partner who supports you and your birth choices
* Choose care options which suit you and your baby’s needs best. You can read more about care options here
* Carve out your own space in labour – labour wards can be busy places try to find a space that you and your partner feel relaxed in – in the shower or bath, go for a walk, explore the hospital grounds or garden, walk the stairs or corridor. If you cannot leave your ward find a way to make space in your own surroundings – draw the curtains and use ear phones to tune out noise. Watch a DVD.
* bring comforts with you – your own pillow, music, a comfy blanket, a heat pack
* have comfort foods and drinks prepared
* dim the lights
* ask for privacy – time on your own in labour or limiting who is in the room with you

“On my first pregnancy I had a long labour with an OP baby, and the hospital was very very busy. I discussed my desire to labour and birth without pain medications with the midwife on duty and she brought me to a private room with a deep bath. I laboured in there for hours in the warm water with just my husband. By the time she came to check me, I was well on my way to giving birth!”

Birthing Suite in Cavan MLU

Put on a Birthing Filter

We are bombarded by the tv, movies, soaps, and newspapers – all trying to out-do themselves to show birth as dramatic, dangerous, and painful. While this may seem harmless – you might not even think about it – these images and stories are being stored in your memory bank and to make up your internal belief system about how you feel about giving birth. If you only hear and see mostly negative stories and images of birth, this is likely to be your reality. While if you see and hear mostly positive images and stories of birth, you are reinforcing positive healthy birth as your reality.

In the last decade birth programs have become popular viewing on mainstream television. You may feel that watching these programs will prepare you for labour and birth. Unfortunately, many of these programs only highlight routine obstetric led practices and reinforce interventions which are not supported by evidence. These programs have a big part to play in how you view birth and reinforce that unnecessary interventions and practices that are not supported by evidence are normal and OK despite the increase in risks to you and your baby.

Horror stories serve no purpose to you in pregnancy. It is one person’s experience. They will not make you more informed. Surround yourself with positive birth stories and images during your pregnancy.

“The factor that best predicts a woman’s experience of labor pain is her level of confidence in her ability to cope with labor”(Lowe 2002).

Try to surround yourself with women with similar birth choices to support one another, bounce ideas off, rant to! Sometimes, especially if this is a first baby, women can feel alone, unsure, or overwhelmed in pregnancy. A strong support network with like-minded women can be extremely reassuring. Women supporting other women is invaluable. Seek out women whom have given birth without medical pain relief. Ask them to share their stories and any tips they may have.